Worth Cuts 24/7 Access, Doubles Down on Wellness

Swarthmore’s 24/7 medical services are a thing of the past. In line with the College’s emphasis on wellness, Worth Health Center has cut Tuesday night shifts and is using the surplus resources to support the new Wellness Coordinator position, held by Satya Nelms.

Director of Health Services Beth Kotarski said, “just losing that 12 hour Tuesday night slot throughout the whole 36-week year, we are able to then shift those financial resources to have Satya come full time.” She said this change moves the Health Center away from an older, and permanent-access infirmary model to a more holistic one that emphasizes wellness and prevention.

“The model has shifted to health services being a primary care site where we take care of a whole spectrum of care,” said Kotarski. Nine infirmary beds existed 60 years ago when the Worth Health Center first opened. There are two beds now, with three if needed.

But why cut the 24/7 in favor of the Wellness Program?

After many years of data collection (based on the slips patients fill out at the Center), Kotarski discovered that demand for services at night was extremely low. On average, only one student visited the Center on a Tuesday night. The Center receives about 9000 visits per year, or about 250 a week, on average.

A large proportion of visits to the Center involve upper respiratory symptoms such as colds or the flu and are handled in the daytime. A wide variety of non-urgent services are also provided at the Worth Health Center, like flu shots, physical checkups for travel and work, to reproductive health services.

By contrast, urgent (and rare) overnight visits are likely serious enough to merit a hospital visit, so a nurse is on-call from public safety on Tuesday nights. Kotarski suggests that night services on the weekends will not likely be cut. “It’s not very good for you as a student to take care of yourself at 2 o’clock in the morning,” said Nurse Eileen Stasinunas.

While student demand for night services were low, student health surveys have revealed that students desire more programs regarding wellness, according to Nelms. Surveys are distributed by the Student Health Advisory Committee (SHAC) in the yearly wellness fair.

The age-old dilemma of “Academic success, social life, and adequate sleep: pick two,” is the key balancing act for the wellness program. Preventing illnesses is part of the balance. Activities like yoga, zumba, meditation, peer-to-peer counselling, and more are part of a large array of initiatives to create a healthier environment.

Nelms has been involved in everything from meeting students one-on-one to being part of Residential Assistant and Student Academic Mentor trainings. “I try to institutionalize wellness as much as I can,” said Nelms.

Wellness development isn’t unique to Swarthmore. Bryn Mawr College has a mandatory Wellness seminar for freshmen. Wesleyan University, which Nelms attended, has students heavily involved with student peer educators. Nelms is seeking to shift to a peer-educator model, with the hope that students will better receive information.

Cost-benefit analysis has resulted in a reshuffling of Worth staff during the day as well. It became clear that students visit more often in the afternoon when classes finish, so more nurses are available in the afternoon than in the morning. The number of nurses overall has fallen, and they now undergo more specialized training.

“We kind of play a game of shifting things around rather than always asking for new money for new initiatives,” said Kotarski. According to Kotarski, no additional funding has been requested for the health services since her arrival in 2007. This means that when new initiatives like the Wellness Program come along, something like Tuesday night shifts have to go.

Part of the willingness to enact change in health services is consistent communication with students. Kotarski formed SHAC in 2007 as a key consultative arm for her. She realizes that a shift away from the 24/7 model will gain attention and require community involvement in the issue.

In the first SHAC meeting of the year, a suggestion box was brought up. Even a rigorous, per-visit feedback form akin to the Writing Associates program was considered. Other proposals included increased transportation options to off-campus hospitals and clinics, as well as an electronic appointments system, all based off student feedback. Behind the scenes, Kotarski is in the investigative stage of looking into electronic systems for record management to supersede the current paper-slip system.

Mondira Ray, an economics major who is also following a pre-med track, has served on SHAC for four years. She recalls this shift in attitudes towards students’ health. “I think the biggest change of movement in health services is promoting healthiness and nutrition,” she says.

Ray admires the efforts made by Kotarski in the past four years. But within this praise she hints that even improved efficiency and resource allocation cannot overcome certain limitations. Ray said, “I just found it remarkable how willing [Kotarski] is to stand up [to] pressures from external sources like the administration [or] financial pressures.”

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0 comments

The long- term endowment returns are the relevant ones. In 2011-12 Swarthmore’s endowment earned just 2.2% and over the past ten years it has earned an average of a little over 8%. While there are occasional years of high returns as in 2010-11, it is these longer term returns that the endowment spending is planned around. Swarthmore’s endowment provides 45% of the budget. Its growth enables annual increases in financial aid, faculty and staff salary increases, and most recently the restoration of funds for facilities projects (after 3 years of much reduced levels in response to the economic downturn).

I don’t think our endowment funds things like that, or at least not completely. It’s likely the Annual Fund or some sort of charitable giving. If the Annual Fund provides almost all of our financial aid and teacher compensation(which it does), I don’t see why it wouldn’t be supporting Worth and Wellness.

This also goes for paying the people who staff our college an actual living wage or reevaluating (not) funding certain academic departments. I think my general point is what is the logic behind exponentially growing our massive endowment (1.5 billion dollars and counting) if we’re not going to put that money to responsible and reasonable use.

Half of the colleges operating budget each year comes from endowment returns and the other half from tuition and the annual fund. Usually the college anticipates around a 5% return on endowment investments to cover this half. The extra 20% made last year was just re-added to the endowment.

I understand being frugal even when the college is doing well but at some point it crosses the line into ridiculous… like closing the health center on Tuesday nights to pay for a wellness coordinator position. It’s not necessarily a *good* thing that Worth hasn’t requested a budget increase since 2007. As the college grows, facilities and services have to grow with it, especially when we obviously have the means to do so.

Major kudos to Beth Kotarski for being such a voice of reason on campus and steering the Worth in a great direction these past few years. But *honestly* … this is ridiculous. The college has enough money to hire a wellness coordinator AND have Worth stay open on Tuesday nights, even if it is for one or two students. Our endowment yielded an unprecedented 25% last year. Why aren’t we actually using that money for initiatives like these instead of shuffling resources around?

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